Clinicians in Western NSW Local Health District (WNSWLHD) have successfully piloted the ADHD and Behaviour Management Service, a new telehealth model to improve access to paediatric assessment and diagnosis of ADHD.
In partnership with the Sydney Children’s Hospitals Network (SCHN), the service creates linkages to general practitioners (GPs) through co-management, and develops value-based care while streamlining usage and skills of paediatricians.
Referrals come from existing paediatric outpatient services and offer a comprehensive multidisciplinary team review. Once a patient/referral is deemed suitable, assessments are conducted in schools, while carers participate via telehealth. GPs are engaged from the start and continue to support with co-management when appropriate, in accordance with AADPA guidelines.
Early diagnosis is key
Delayed diagnosis and treatment of ADHD is estimated to cost the health system $39,267 per child annually.1 Children within WNSWLHD face significant barriers to ADHD assessment and diagnosis. For children triaged through the service, the average time spent on public paediatric waitlists before accessing our virtual paediatrician is 687 days, with 18.4% waiting more than 1,000 days for paediatric support. Early diagnosis and intervention can mitigate long-term effects and reduce associated morbidity.2
The ADHD and Behaviour Management Service is delivered virtually, with school-based assessments for children and telehealth consultations for carers. While telehealth is not new, the model represents an innovative approach to coordinated ADHD care through integration of virtual clinical care across education settings in partnership with WNSWLHD and SCHN clinicians and local GPs.
The service provides families with comprehensive ADHD assessment and management at no cost. Comparable private assessments range from $1,500 to $3,000. By delivering care via telehealth, the service eliminates travel-related expenses and disruption for families, particularly those in remote areas where a single appointment can require days off work, school absences and accommodation costs.
The telehealth model also reduces clinician travel and maximises productivity. On average, 3.5 to 4 hours of clinical time is required per client to complete the full intake, multidisciplinary team meeting, psychology assessment, and paediatric assessment – representing a highly efficient use of clinical hours. In many cases, this entire process can be completed in the time it would take a family to travel to a face-to-face appointment.
Championing collaboration and co-management
To address long waitlists, geographic barriers and the cost of paediatric care, our team developed a structured telehealth model tailored for rural families. The service includes 2 key pathways:
- comprehensive assessment, diagnosis and paediatric telehealth support
- GP co-management, supported by dedicated GP Co-Management Coordinators.
We worked closely with local paediatricians, allied health staff, Wellbeing Nurse Coordinators, school counsellors, Department of Education representatives and parent advocates to shape a model that would meet the needs of families in Western NSW. Collaboration with the SCHN enables the delivery of specialist services, including paediatric and clinical neuropsychologist consultations, entirely via telehealth.
Weekly multidisciplinary meetings guide intake and clinical decision-making. Resources were developed to support schools and GPs, including fact sheets, handover templates, and escalation pathways. Assessments are conducted via an online telehealth application (Coviu) while children remain at school, allowing clinicians to connect across considerable distances. Research has shown telehealth assessments are comparable to face-to-face care,4 and schools provide valuable insights into children’s daily functioning and support needs.
A dedicated GP Co-Management Coordinator ensures seamless transitions by onboarding GPs and empowering parents and carers, reducing reliance on specialists and strengthening community healthcare capacity. Establishing structured communication pathways among families, schools and GPs, the service model ensures truly patient-centred care. Patients actively participate in decision-making processes, and families report increased confidence and support in managing ADHD.
Improving access to care
Since its inception, this pilot has reduced wait times, improved access to care and strengthened collaborations across health, education and primary care to deliver better outcomes for our communities. This includes working with 77 schools across Western NSW to deliver school-based assessments.
Parent and carer feedback highlights reduced classroom disruption, improved attention and greater capacity for individuals to remain engaged in learning – key predictors of long-term success and equity in education and health outcomes.3 Local GPs have expressed increased confidence in managing ADHD, and schools have noted enhanced collaboration and understanding of neurodevelopmental conditions.
Since March 2024, the assessment pathway has reviewed, triaged and assessed 431 children. Since November 2024, the co-management pathway has processed 277 referrals from local paediatricians, projecting to save 720 paediatric outpatient appointments in 12 months, equating to 540 clinical hours.
In one case, an 8-year-old Aboriginal child in kinship care, living in remote NSW, waited 644 days on a public waitlist. The child was unable to travel for care. With school-based support, they received a timely telehealth consultation and diagnosis, and commenced stimulant medication. Their school attendance improved from partial to full days, with notable behavioural progress. Their family and teachers reported significant improvements in functioning and wellbeing.
Moving forward, there is a focus on expanding to more schools and remote communities, strengthening GP education and co-management and contributing to statewide virtual ADHD care strategies. We're also exploring research partnerships with SCHN and the University of Sydney to support ongoing evaluation and innovation.
References
- Daley, D, Jacobsen, RH, Lange et al. (2019, September). The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. European psychiatry : The journal of the Association of European Psychiatrists, 61, 41-48. https://doi.org/10.1016/j.eurpsy.2019.06.011
- French, B., Daley, D., Groom, M., & Cassidy, S. (2023, October). Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. Journal of Attention Disorders, 27(12), 13931410. https://doi.org/10.1177/10870547231176862
- Sciberras, E., Streatfeild, J., Ceccato, T., Pezzullo, L., Scott, J.G., Middeldorp, C.M., Hutchins, P., Paterson, R., Bellgrove, M.A., & Coghill, D. (2022, January). Social and Economic Costs of Attention-Deficit/Hyperactivity Disorder Across the Lifespan. Journal of attention disorders, 26(1), 7287. https://doi.org/10.1177/1087054720961828
- Hodge, M. A., Sutherland, R., Jeng, K., Bale, G., Batta, P., Cambridge, A., ... & Silove, N. (2019). Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder. Journal of Telemedicine and Telecare, 25(7), 431-437.
- Hodge, M. A., Sutherland, R., Jeng, K., Bale, G., Batta, P., Cambridge, A., ... & Silove, N. (2019). Literacy assessment via tele practice is comparable to face-to-face assessment in children with reading difficulties living in rural Australia. Telemedicine and e-Health, 25(4), 279-287.
